Department of General Surgery (Colorectal Surgery), The Sixth Affiliated Hospital, Sun Yat-sen University, China; Department of Medical Oncology, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, 510655, China; The Fourth Affiliated Hospital of Dali University, Chuxiong, China.
Department of General Surgery (Colorectal Surgery), The Sixth Affiliated Hospital, Sun Yat-sen University, China; Department of Medical Oncology, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, 510655, China.
Eur J Surg Oncol. 2024 Nov;50(11):108651. doi: 10.1016/j.ejso.2024.108651. Epub 2024 Sep 2.
The incidence of rectal neuroendocrine tumors (RNETs) has witnessed a significant surge, with a notable proportion being amenable to endoscopic removal. However, the clinical significance of positive resection margin for RNETs patients following endoscopic resection remain unknown, resulting in a lack of consensus regarding the appropriateness of implementing salvage treatment.
In this large, multicenter, retrospective cohort study, we analyzed the medical records of individuals who underwent endoscopic resection for RNETs and classified them into two groups: the positive resection margin and the negative resection margin group. The overall survival (OS) and disease-free survival (DFS) were compared among two group. The independent variables were identified using univariate and multivariate logistic regression analyses to predict positive resection margin. Then, the model was established to predict the patients with positive resection margin using multivariate logistic regression.
181 RNETs patients (34.3 %) represented positive margin after endoscopic resection. Following a median follow-up period of 72 months, tumor recurrence manifested in 12 out of 527 patients (2.2 %) and the presence of positive resection margin was associated with worse DFS. Independent factors correlating with positive resection margin included endoscopic resection method choice, RNETs located in the low rectum, NLR >4.44 and tumor size exceeding 14.89 mm. A prediction model was therefore established with high predictive accuracy and excellent clinical applicability determined by calibration curves and DCA curve. Among RNETs patients with positive margin following endoscopic resection, implementing salvage treatment was beneficial for improving DFS and salvage endoscopic resection offer equal efficiency compared with salvage radical resection.
Positive resection margin following endoscopic resection may indicate negative prognosis. Salvage treatment can improve the prognosis of RNETs patients with positive resection margin. Notably, salvage local resection exhibited similar efficacy compared with radical surgery in term of survival benefit.
直肠神经内分泌肿瘤（RNET）的发病率显著上升，其中相当一部分可通过内镜切除。然而，内镜切除后 RNET 患者切缘阳性的临床意义尚不清楚，因此对于是否实施补救治疗存在争议。
本研究是一项大型多中心回顾性队列研究，分析了接受内镜下 RNET 切除术患者的病历，并将其分为切缘阳性和切缘阴性两组。比较两组患者的总生存期（OS）和无病生存期（DFS）。采用单因素和多因素逻辑回归分析确定独立变量，以预测切缘阳性。然后，采用多因素逻辑回归建立预测模型。
181 例 RNET 患者（34.3%）内镜切除后为阳性切缘。中位随访 72 个月后，527 例患者中有 12 例（2.2%）肿瘤复发，且切缘阳性与 DFS 较差相关。与切缘阳性相关的独立因素包括内镜切除方法的选择、肿瘤位于直肠下段、中性粒细胞与淋巴细胞比值（NLR）＞4.44 和肿瘤直径＞14.89mm。因此，建立了一个具有较高预测准确性和良好临床适用性的预测模型，校准曲线和决策曲线分析显示其具有较高的预测价值。在接受内镜切除后切缘阳性的 RNET 患者中，实施补救治疗可改善 DFS，且与根治性切除相比，补救性内镜切除的效果相当。
内镜切除后切缘阳性可能预示着不良预后。补救治疗可改善切缘阳性的 RNET 患者的预后。值得注意的是，在生存获益方面，补救性局部切除术与根治性手术疗效相当。
